Operative outcome of high energy pilon fractures: a retrospective comparison between internal fixation and Ilizarov external fixation

Authors

  • Satya Ranjan Patra Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Dasarath Kisan Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Naresh Kumar Panigrahi Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Dibya Singha Das Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Medini Manoj Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Saswat Samant Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India
  • Anmol Shiv Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20170078

Keywords:

Pilon fractures, Plafond fractures, Ankle, Ilizarov, Minimally invasive surgery, Ligamentotaxis

Abstract

Background: Pilon fractures are serious injuries with many devastating soft-tissue complications associated with them. Deciding a definite treatment plan has always proved a challenge. Comparative studies between the various surgical techniques used for pilon fractures are uncommon and consensus is yet to be reached regarding the best surgical option. Purpose of this study is to retrospectively compare the operative results (complications, functional and radiographic outcomes) of pilon fractures treated either with internal fixation or Ilizarov ring fixators.

Methods: Forty-six patients with pilon fractures were retrospectively studied; twenty-one of them had minimal invasive fixation by ankle spanning Ilizarov fixators and 25 patients had internal fixations by either minimal invasive plate osteosynthesis (MIPO) or by open reduction.  The patients were followed-up for a mean of 34 months (range, 24-51 months).

Results: The internal fixation group had a higher incidence of soft-tissue complications and deep infections. In comparison the Ilizarov group had only superficial pin-tract infections but no other soft-tissue complications. Although the Ilizarov group had a higher incidence of malreduction and malunion in their series compared to the internal fixation group, there was no significant difference in the AOFAS ankle function score (p-value 0.2922) between the two groups after a follow-up of 2-4 years.

Conclusions: The moderately long term functional outcome appears to be similar in both internal fixation and Ilizarov groups. But the Ilizarov technique is less likely to cause any serious peri-operative soft-tissue complications or deep infection. Familiarity of the surgeon with a particular technique should also be considered during surgical decision making. 

Author Biographies

Satya Ranjan Patra, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Associate Professor

Department of Orthopaedics

Dasarath Kisan, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Associate Professor

Department of Orthopaedics

Naresh Kumar Panigrahi, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Senior Registrar

Department of Orthopaedics

Dibya Singha Das, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Senior Registrar

Department of Orthopaedics

Medini Manoj, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Resident of Orthopaedics

Saswat Samant, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Resident of Orthopaedics

Anmol Shiv, Department of Orthopaedics, Hi-Tech Medical College & Hospital, Bhubaneswar, Odisha, India

Resident of Orthopaedics

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Published

2017-02-22

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Original Research Articles